This implementation toolkit is designed to enhance the efficiency and reliability of your quality improvement efforts. The elements are based on well-proven principles of quality improvement, personal experiences, and evidence-based medicine. Using the methods, tools, and information provided in the implementation toolkit will help you close the gap between known best practices and common, often sub-optimal, methods for caring for the inpatient with hyperglycemia.
Learn how “sweet” SHM's Glucometrics Reports are and how to benchmark your hospital against other Glycemic Control Program participants. Track your performance through the Electronic Quality Improvement Program (eQUIPS) or join the Glycemic Control Mentored Implementation Program, which leads institutions through the process of implementing the principles outlined in this toolkit. SHM is now accepting applications to the Fall 2014 GCMI Program.
The Glycemic Control Implementation Toolkit will enable you to implement effective regimens and protocols that optimize glycemic control and minimize hypoglycemia in your institution by providing you with information on:
The Glycemic Control (GC) Implementation Toolkit is the online version of the Glycemic Control Implementation Guide and addresses in detail the essential elements for reaching breakthrough levels of improvement in the care of hyperglycemic inpatient. Review the How to Use portion of the toolkit for guidance and an introduction to the information you will find in the implementation toolkit whether you are just beginning a quality improvement (QI) initiative or have made considerable progress.
Download and print the Glycemic Control Implementation Guide/Supplement entitled, Workbook for Improvement: Improving Glycemic Control, Preventing Hypoglycemia, and Optimizing Care of the Inpatient with Hyperglycemia and Diabetes, which serves as the portable version of the Glycemic Control Implementation Toolkit.
Set up your team for success. Move ahead only with the support of your institution and an understanding of your environment. Know where you are going and how you will get there by setting goals and using a framework for improvement.
Review what the literature says about inpatient glycemic control. Package that knowledge into a protocol that is aligned with the scope of your project.
Diagram your current care delivery. Understand its inter-related steps and failure modes. View care delivery as a series of intermediate steps leading to the clinical endpoint of interest. Recognize which steps should become metrics for glycemic control, safety (including hypoglycemia), and insulin use patterns.
Select key metrics. Collect the data needed to track performance on these metrics. Plot and report data on a run chart. Write the aim statement that will be your benchmark for success. Consider tracking balancing measures.
Start with standardizing processes and protocols for critical care settings, non-critical care settings, transitions, and perioperative situations. Embed guidance from your protocols into your order sets as much as possible while integrating these tools into the flow of patient care. Then, raise performance incrementally by moving up a hierarchy of increasing reliability.
Learn by testing and refining change in the clinical setting. Revise the protocols and order sets to embrace appropriate variation. Take steps to weed out inappropriate variation. Spread your improvements to other units.
Insulin infusion or physiologic subcutaneous insulin regimens that are tailored to the patient's nutritional status and other factors are the best ways to control hyperglycemia in the hospital. The implementation of such regimens can only be safe and effective in improving glycemic control when achieved with a multidisciplinary team.
Read about Sutter Health Network's, "Implementing New Order Sets and Advancing Glucose Control"